WY Chu, Surgery, Tuen Mun Hospital, NTWC

Initial management as a HST in rupture HCC

Catastrophic event Initial management is important

Stop bleeding

Identify potential long term survivors

Chan SY, F/43, @ 15.7.2007

Known HBV carrier, L lobe liver mass Sudden onset RUQ pain with shock BP 70/45 P110, confused Bedside USG: FF in Morrison’s pouch Child’s A, Hb 12 g/dL CT abdomen with contrast

Hemodynamically unstable

Chan SY, F/43, @ 15.7.2008 Laparotomy: 4 cm S2&3 ruptured HCC,

cirrhosis, 2L blood with clot Perihepatic packing & LHA ligation at

falciform ligament level Further resuscitation in ICU 2nd stage laparotomy 24 hrs later Left lateral sectionectomy Discharged post-op D7 Last FU 8.8.2008: well no recurrence

TMH series 2004-2007

Survival:

32 months (12-48) Survival:

7 months

(3-8)

Early diagnosis

? Men? Younger age? Trauma hx

? Known HCC? Cirrhosis

? HBV / HCV

? Shock? RUQ/

epigastric pain ? Abd distension/

peritonism ?USG : FF

Early Resuscitation

Correct coagulopath

y

Blood Transfusion

Assessment of patient

Independent poor prognostic factors for 30 day mortality

Tan et al, ANZJ Surg 2006

Candidate for liver resectionWang et al, ANZJ Surg 2008

Early CT scan

? Peripheral location? Well-

defined tumor

? Portal vein thrombosis

Early Transarterial embolization TAE

To stop arterial bleeding Success rate: 83-100% Liver failure rate: 19-29% Re-rupture rate: up to 35%

Lai et al, Arch Surg 2006

Early operation

Open hemostasis Operable and unstable Stop the venous bleeding

Liver resection

Survival benefit can be observed in patient with curative liver resection.

Lai et al, Arch Surg 2006

One stage resection: shorter hospital stayLiu et al, World J Surg 2005

TMH: 2nd staged operation 24 hours later

Summary Life threatening event Multidiscriplinary approach Stop bleeding

Identify the potential candidate who can have long survival after Rx

ENDThank you